Creative Care Dorset Conference 19/11/2013
Hello everyone and thank you very much to Roz for inviting me to speak today. I am very pleased to be here. Many of you will know that I am almost a Dorset citizen having only recently left my post of Arts Coordinator at Dorset County Hospital, after 15 years there, and very recently moved to Oxford, after 19 years living in Bridport. Although my role as Director of Arts & Health South West is regional I am still very involved in work here in Dorset and I will talk a little bit more about that later. Roz didn’t give me any particular guidance for today – she just said that she wanted me to impersonate Lord Howarth of Newport and give as rabble rousing and inspirational a speech as he gave at the Culture, Health and Wellbeing International conference in June in Bristol. I have told Lord Howarth that I am attempting to impersonate him today but I must say I think it is a tall order and it is a great pity for all of you that he isn’t here in person as he was truly wonderful and gave us all renewed energy and commitment to our work. I will quote a bit from his speech later and you can download it from the conference website.
A little bit about Arts & Health South West first and what is happening nationally and internationally. Arts & Health South West is an information, support and advocacy organisation for people who believe in creativity in enhancing people’s health and wellbeing. One of our primary roles is to connect people, to foster networking, partnership working and the exchange of knowledge and experience. We are a free membership organisation with more than 900 members, mostly in the South West but also national and international.
We influence at a strategic level advocating for the arts and health with policy makers, decision makers and funders. We are working to
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influence Health and Wellbeing Boards across the region, primarily through our support to sub-regional networks such as Creative Care Dorset. In Dorset we are working with Creative Care Dorset and the Dorset Cultural Partnership to present a project idea to the Dorset Health and Wellbeing Board around using the arts to consult with communities about their health and wellbeing experiences and needs. The Director for Public Health, David Phillips, is supportive of a plan to develop some pilot work around three of the priority areas in the Health and
Wellbeing
Dementia;
Strategy:
Reducing
Improving
anxiety
and
Care
for
People
depression;
with
Improving
circulatory health. Dorset has a track record in arts and health work that contributes to these priorities.
We develop the field through both practice and making the evidence base more accessible.
In an action learning project with 7 acute
hospitals, nursing staff and arts coordinators are coming together to develop the use of the arts for people with dementia, with the aim to create a digital resource to support arts and dementia work in hospitals across the region. In partnership with GPs and the NHS Wessex Local Area Team, which covers Hampshire, Dorset and the Isle of Wight, we hope to develop arts on prescription across Wessex.
Nationally the newly formed National Alliance for Arts, Health and Wellbeing is lobbying at a policy level. Lord Howarth is leading on an All Party Parliamentary Group on Arts and Health, which will provide a platform for debate and information sharing with parliamentarians. A programme of speakers is planned to start in the New Year. This will cover issues such as ‘Dignity in Care’; ‘What we know works’ and ‘Wellbeing and Culture’, as well as offer a focus on certain health needs and specific art forms such as music and chronic illness; dance and Parkinson’s disease; environments for cancer care and the arts and
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post-traumatic stress. Is it is as much about raising awareness and imparting knowledge to parliamentarians, of all political parties and across both houses, as it is about a specific aspiration to influence policy. Arts and health is still relatively unknown territory for many politicians, clinicians and members of the public and it is beholden on all of us to change the future narrative about health and wellbeing by talking about it more articulately and more frequently. To quote from the National Alliance for Arts, Health and Wellbeing’s Charter: The arts, creativity and the imagination are agents of wellness: they help keep the individual resilient, aid recovery and foster a flourishing society.
At an international level we are building on the Culture, Health and Wellbeing international conference to maintain dialogue and the exchange of knowledge and experience. The conference website is becoming the Culture, Health and Wellbeing International Exchange and will feature pages on the 22 countries who were represented at the conference with regular updates about activity in their countries. It will link the new UK Arts and Health Research Network to research activity internationally and help the process of drawing together the evidence base, which we all need to be able to access, understand and use in developing our work.
We seem to go round in circles when it comes to evidence and evaluation. The health service places emphasis on ‘evidence-based practice’ and even those in health who are convinced of the value of arts and health work want to know what evidence there is in order to justify funding it or in order to manage criticism from the sceptics and the press. From the arts side there is an awareness and an anxiety about the need for evidence and robust evaluation but often a lack of confidence or unfamiliarity with the language and methodologies that
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are used. That is not to say that all medical practice is based on good evidence and the whole issue is fraught with contradictions and complexities. However, we must engage with this issue and do our best.
I mentioned the new UK Arts and Health Research Network. This brings together academics from across the country who are committed to working with practitioners and each other to identify the gaps in the evidence base, to make it more robust and comprehensive and to support practitioners in evaluating their work. There is a long way to go but be reassured that everyone expects us to continue delivering the work as we progress towards the goal of evidence based arts and health practice. I loved the comment by a medical professional from New Zealand at the international conference, who said: ‘there is no randomised control trial for the effectiveness of a parachute’.
Sometimes our work is as effective as a parachute. We only have to look to ourselves in this debate. I avidly read all new evidence that circulates and try to grasp the significance of it, but one of the key moments for me in my Arts and Health journey was a conversation at the last Creative Care Dorset conference here at Herrison Hall. I was talking to someone who had taken part in the REACH arts on prescription scheme which I had project managed. When it dawned on her that I had been involved in REACH her whole face lit up and she said that REACH had been the only thing in her long experience of mental health services, which had completely changed her life and made her truly better able to cope.
REACH was based on an arts on prescription model and as I mentioned earlier Arts & Health South West is pushing to scale this up across the Wessex Local Area with the idea that we might then be able to
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convince
Clinical
Commissioning
Groups
to
commission
arts
on
prescription work across a wider geographic spread. This no longer seems like pie in the sky thinking. I was recently sent an email about Gloucestershire Clinical Commissioning Group wanting to advertise a commission for an arts on prescription scheme. In Bristol the Artshine Arts on Referral programme has been taken on by mental health services across the city. Arts and Health work is very broad and comes in many shapes and forms but arts on prescription is one way of delivering it that I think has real potential to provide us with the critical mass of participants that we would need to move the evidence arguments on a bit.
I haven’t talked to you about the many different approaches to arts and health ranging from the marvellous work dance organisations are doing for people with Parkinson’s, or the amazing contribution to creating dementia friendly cities that our museums and galleries are making with their collections and reminiscence and object handling work, or indeed the fact that for artists this kind of work can expand their humanity and introduce them to entirely new ways of thinking about their practice – can change their artistic practice profoundly.
The talk by David Leventhal at the international conference in June was a recent highpoint. He is a dancer with the Mark Morris Dance company in New York and is behind the international Dance for Parkinson’s movement which is now spreading in several countries, including the UK. Here Dance South West has recently showcased their Dance for Parkinson’s work and many of you will know Amanda Fogg, a Dorset based dance artist, who is a leading light in the UK Dance for Parkinson’s network. The English National Ballet is also very involved in this area of work and Sara Houston from Roehampton University has written about her research for them on the subject of beauty. She
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quotes one participant as saying: ‘I feel beautiful again’ after taking part in a dance for Parkinson’s session. A simple response but one with so much to it. The loss of identity associated with chronic illness where the illness itself is the lens through which health professionals and sometimes friends and family see the person; the loss of confidence in one’s ability to be part of the world, to be visible in the world and attractive; the transformatory power of the arts.
Hearing a performance of Bewitched, a new composition for string quartet and soprano by Ian Wilson, was a transformatory moment for me. Ian Wilson was composer in residence in the stroke unit at Tallaght Hospital in Dublin and created Bewitched in response to that experience and with the words from conversations he had with patients, relatives and staff. As a result of feedback from patients, to the music he was composing, he decided to combine the new compositions with old favourites based on a Doris Day CD that was frequently played in the Stroke Unit. He talked to a young woman who had had a stroke after the birth of her first child, and to her husband who was very distressed. The piece, when sung by the soprano Deirdre Moynihan, took you into the head of the young woman, struggling to speak and to say the word ‘water’. You are trapped with her inside unable to communicate, feeling frustration and fear, and then the song moves seamlessly into ‘Fly me to the Moon’ and with her your imagination soars, you escape and feel free from the physical constraints of the world. It was one of the most moving things I have ever heard.
That was a beautiful experience for me. Grayson Perry spoke very engagingly about the difficult relationship artists have with ‘beauty’ in his recent Reith Lectures. Contemporary art has in some ways severed the relationship between art and beauty – I am not sure why –perhaps beauty
has
become
something
we
consider
unchallenging,
not
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intellectual or conceptual enough – too easy or perhaps cloying, false. But we all know it when we see and feel it. Professor Semir Zeki’s research into beauty with MRI scanning shows that when we view something that we perceive as beautiful it releases dopamine and other feelgood hormones into our system, giving us a physical high. It is good for our wellbeing.
Arts and health isn’t always about beauty of course and health environments have many sights and sounds in them that are very far from what we would associate with beauty. In Peter Snelling’s film ‘Blood Makes Noise’ – which I think you will have the opportunity to see later – we are exposed to the day to day challenges of life as a Renal Dialysis patient and we see a kidney transplant operation, which might provoke feelings of revulsion in some. But beauty here is more subtle – the film is a testimony to the power of the arts to express deep personal narratives, stories that don’t easily get heard and for some of the participants stories that they had never felt able to tell before. The effect on clinicians viewing it was striking – they understood, perhaps for the first time, the true impact of dialysis on the patient’s whole lives and on those of their families. The film also brings out through individual stories the complex issues around transplants – the waiting without knowing, sometimes for years, who donates and what the implications are - if they are strangers, relations or friends.
Many of you are engaged in delivering this remarkable and rich array of work, helping to make our world and the worlds of many people whose experiences in life are sadly wearying and hard, into better and more fulfilling places. Here is something from Lord Howarth’s address to the Culture, Health and Wellbeing conference to help re-energise you all: ‘By
patiently,
persistently,
reasonably
explaining
to
clinicians,
commissioners and managers, as well as to social workers and local
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authority officers across the country, that what you offer works, is inexpensive and cost-effective, is loved by patients and by frail elderly people, is loved too by staff, you will increasingly succeed in changing practice, improving the culture, developing a new wisdom. It will be a long march through the NHS and Social Services, but you will increasingly find acceptance.’
Health can seem such a monolith, so vast and taken so seriously. In the arts we believe in the value of what we do, we know that the imagination and poetic sensibility are profoundly important for us as human beings but we live in a world dominated by science and logic and we struggle to keep our heads high and to feel that we are on an equal playing field.
However, health services for all their power and weight are beset by endless problems and set backs. Despite our nation’s famous faith in the NHS, recent realities such as those exposed at Mid-Staffordshire Hospitals or the abuse of people in Winterborne View must result in waning public confidence in the integrity and quality of our health and care services. But the official response to these problems seems to be dominated by a tightening of regulation and reporting, bureaucratic rather than about behaviour change.
Lord Howarth spoke very eloquently about this when he said:
‘The remedies for the crisis of the NHS will not be bureaucratic or mechanistic. They will be about the spirit of the NHS, its ethos, the morality and the morale of the people who work in the NHS; about the quality of human relationships, mutuality, reciprocity and trust within this vast structure; about reimbuing care with true humanity. They will be about seeing the patient as a human being, not as a case or a
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statistic. The values and the practice of the arts in health movement point the way. You understand what is needed to bring healing and wholeness to wounded, suffering lives. You have the passion, the selfbelief, the commitment. Your work embodies kindness, whether you are
preventing,
easing,
sustaining,
curing,
mitigating,
palliating,
comforting. You go beyond technical healthcare to supporting healthy lives, lives of wellbeing, and - when the time comes - good deaths.’
Yesterday I was at an event on music and dementia with care home providers,
nursing
staff,
musicians
and
arts
organisations.
The
trajectory of dementia takes in that life course. Having type 2 Diabetes doubles your chance of getting dementia and tackling obesity starts with encouraging breast feeding for babies; recent research in Canada showed that those involved in the arts all their lives have brains which are more resistant to Alzheimer’s because the creative brain is more adept at creating new pathways (probably a somewhat simplified summary); and I heard some very moving stories about taking music to people with dementia near the end of their lives and how when all other forms of communication have gone music can still connect people to the here and now. There are many causes and challenges that we face in our world and we all choose the direction we wish to take with our work. I have found it very rewarding and fascinating to work with the arts and health and I am very grateful that my career has taken me along this path. It is a dynamic time to be working in this field and there is a gathering momentum that I hope you can all feel and be part of. Thank you for listening and I look forward to hearing more about what everyone is involved in during the rest of today..
Alex Coulter Director of Arts & Health South West alex@ahs.org.uk www.ahsw.org.uk
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